Retention of Knowledge:

__3__Consistently interprets and applies learned information __2__Retains information well

__1__Requires some repetition of information __0__Requires repeated explanations

Total Value: ___________ Points toward Clinical Experience Grade: ______ Value of 27 – 30: indicates exceeds expectations……….16 points Value of 19 – 26: indicates meets expectations………15 points Value of 15 – 18: indicates below expectations………11 points Value of 11 – 13: indicates improvement required……….. 7 points Value of 10: indicates major improvement required………0 points

The points applied to the clinical grade on the midterm and final clinical grade worksheet is indicated on the scale to the right, above. Fifteen clinical grade points indicate an expected level of performance with 1-point bonus for exceptional behavior.

Evaluator: __________________________________Date: _______________________ Student Signature: _________________________________Semester: _____________ Comments: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Revised: 8/07,6/10cc

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FULTON-MONTGOMERY COMMUNITY COLLEGE Radiologic Technology Program

Clinical Experience

Angiography/Special Procedures Area Evaluation

Name: ___________________________________ Semester: _______________

Last First

Class of: _______________ Date: ___________________ Hospital:___________________

Please check the appropriate response (Yes, No, Not Applicable)

The student: Yes No NA

is punctual.

is professionally dressed.

displays acceptable attitude toward: patients staff communicates effectively with: patients staff displays initiative and willingness to learn willingly assists the radiographer

understands and follows proper sterile technique is able to identify anatomy.

is able to identify catheters/guide-wires/etc. applies proper radiation protection procedures. demonstrates initiative in learning the proper use of digital imaging equipment.

Evaluator/Technologist Signature: ______________________________________ Student‟s Signature: _________________________________________________ Comments:_________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ _______________________________________________________________

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FULTON-MONTGOMERY COMMUNITY COLLEGE Radiologic Technology Program

Clinical Experience

Angiography/Special Procedures COMPETENCIES

At the completion of a limited rotation of sophomore students in Angiography/Special Procedures, the student shall be able to do the following:

1. Display a professional attitude and appearance. 2. Assist in comforting and reassuring the patient.

3. Assist in patient education through explaining the basic procedure and answer simple questions of the patient.

4. Assist in preparing the patient for the procedure. 5. Assist the radiographer with the equipment.

6. Follow sterile procedures and maintain sterile field where applicable. 7. Apply proper radiation protection procedures.

8. Identify the basic catheters, guide wires, etc.

9. Bring and discuss, at least, one angiography/special procedure case to Film Critique. Critique Discussion should include:

a. Definition of procedure

b. Equipment, injection method, contrast and dosage, projections, gowning and protective wear

c. Imaging requirements (positioning and exposure) d. Anatomy visualized

e. Pathology visualized f. Clinical information

It is recommended that an Angiography/Special Procedure technologist present, at least, one case during Film Critique class, at least three times each sophomore semester.

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FULTON-MONTGOMERY COMMUNITY COLLEGE

Radiologic Technology Program Clinical Experience

CT Rotation Area Evaluation

Name: ___________________________________________ Semester: ________________________

Class of: _________________ Date: ___________________ Hospital: _________________________

Please check the appropriate response (Yes, No, NA if not applicable)

The student: _{Yes No NA}

is punctual.

is professionally dressed.

displays an acceptable attitude toward: Patients Staff communicates effectively with: Patients Staff displays initiative and willingness to learn.

demonstrates understanding of simple instrumentation principles. demonstrates desire to identify imaged structures and cross sectional anatomy.

Willingly assists CT technologist and others.

demonstrates safe behaviors for self, patient and others.

Evaluator/Technologist‟s Signature: __________________________________________________ Student‟s Signature: _______________________________________________________________ Comments: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________ COMPETENCIES

Upon completion of a limited rotation in the CT Department, the student shall be able to:

1. Comfort and reassure the patient.

2. Explain the basic procedure and answer simple questions.

3. Prepare the patient for the procedure.

4. Apply basic anatomy principles to images produced cross-sectionally.

5. Assist the radiographer in patient education, preparations and procedures.

6. Operate routine scan functions if applicable.

7. Demonstrate effective communication skills.

8. Indicate procedures requiring contrast agents.

9. Maintain safe procedures toward self, patients and others.

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FULTON-MONTGOMERY COMMUNITY COLLEGE

Radiologic Technology Program Clinical Experience Dexa Scan Rotation Area Evaluation

Name: ___________________________________________ Semester: ________________________

Class of: _________________ Date: ___________________ Hospital: _________________________

Please check the appropriate response (Yes, No, NA if not applicable)

The student: _{Yes No NA}

is punctual.

is professionally dressed.

displays an acceptable attitude toward: Patients Staff communicates effectively with: Patients Staff displays initiative and willingness to learn.

demonstrates understanding of simple instrumentation principles. demonstrates desire to identify imaged structures and anatomy. Willingly assists technologist and others.

demonstrates safe behaviors for self, patient and others.

Evaluator/Technologist‟s Signature: __________________________________________________ Student‟s Signature: _______________________________________________________________ Comments: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________ COMPETENCIES

Upon completion of a limited rotation utilizing the Dexa Scan unit, the student shall be able to:

10. Comfort and reassure the patient.

11. Explain the basic procedure and answer simple questions.

12. Prepare the patient for the procedure.

13. Apply basic anatomy principles to images produced.

14. Assist the radiographer in patient education, preparations and procedures.

15. Operate routine scan functions if applicable.

16. Demonstrate effective communication skills.

17. Maintain safe procedures toward self, patients and others.

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FULTON-MONTGOMERY COMMUNITY COLLEGE

Radiologic Technology Program Clinical Experience

MRI Rotation Area Evaluation

Name: ___________________________________________ Semester: ________________________

Class of: _________________ Date: ___________________ Hospital: _________________________

Please check the appropriate response (Yes, No, NA if not applicable)

The student: _{Yes No NA}

is punctual.

is professionally dressed.

displays an acceptable attitude toward: Patients Staff communicates effectively with: Patients Staff displays initiative and willingness to learn.

demonstrates understanding of simple instrumentation principles. demonstrates desire to identify imaged structures and cross-sectional anatomy.

willingly assists MRI technologist and others.

demonstrates safe behaviors for self, patient and others.

Evaluator/Technologist‟s Signature: __________________________________________________ Student‟s Signature: _______________________________________________________________ Comments: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________ COMPETENCIES

Upon completion of a limited rotation in the MRI Department, the student shall be able to:

1. Comfort and reassure the patient.

2. Explain the basic procedure and answer simple questions.

3. Prepare the patient for the procedure.

4. Apply basic anatomy principles to images produced cross-sectional.

5. Assist the radiographer in patient education, preparations and procedures.

6. Operate routine scan functions if applicable.

7. Demonstrate effective communication skills.

8. Indicate procedures requiring contrast agents.

9. Maintain safe procedures toward self, patients and others.

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